Provider Demographics
NPI:1811523558
Name:ATER, DOMINIQUE RENE (MS LPC)
Entity type:Individual
Prefix:MS
First Name:DOMINIQUE
Middle Name:RENE
Last Name:ATER
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:MISS
Other - First Name:DOMINIQUE
Other - Middle Name:RENE
Other - Last Name:BICKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:344 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-2226
Mailing Address - Country:US
Mailing Address - Phone:740-412-2920
Mailing Address - Fax:
Practice Address - Street 1:5 FAYETTE CTR
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-2120
Practice Address - Country:US
Practice Address - Phone:740-335-8228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPP-000333305101Y00000X
OHC.2103239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor